Question

1- Briefly describe ONE Provider complaint that formed the basis of the Managed Care Backlash.

2- Briefly describe ONE Health Plan Member complaint that formed the basis of the Managed Care Backlash.

Answer 1

1-

ONE Provider can meant to be the Consumer-Patient side of Managed Care Revolution; Wherein, Backlash for the Managed Care that has taken form of legislation which has been introduced in nearly every state for the main motive of calming the consumers-Patient's fears of losing control of their Health Care. A significant complaint and Backlash against Managed Care is the problems with the plans they provides to the Consumer, wherein they perceives threatening and events which are dramatic in Managed Care that has aroused them to experience their utmost concern which has been driven by the dilemma of fear of proper sevice care might not be available or paid for when they fall sick.

In Regard to favor of Government regulation towards the Managed Care Backlash, interventions turned out to be not worthy due to high cost constraints on the plan which has raised less in favor of government regulation that appears to reflect;

• The old age consumer between 50-64
• The Consumer with moderate Household incomes
• The Quality of care that are available to patients are hurted by Managed Care.
• The sector is not maintaing and providing better service for patients as compared to professions and institutions in the health care are.
• The Managed care has decreased the quality of Health care for consumer-patient
• The depiction that more Managed care future trend will harm the quality of medical care that consumer-patient like themselves will receive in future.

The Phenomenon that has observed is consumer, who acquires heavy Managed Care are more worried than those with traditional coverage, when focused on their perceived motivations of their own health plans. They are relatively negative about the efforts that has been put forth by Managed care for their health plans that has limited the payments for care that doctor think which they needs. The less favourable view of plan determines, whether it would receive at the right time when they requires the expensive medical treatment.

2-

ONE Health Plan Member can meant to be Hospital, Physician, or other providers that has agreement with Managed Care Health Plan Providence that tend to provide care to plan members. In recognizing the need for cost management;

• The specialists in general fear a loss of income as a result of Managed Care.
• The Specialists has suffered a loss of autonomy and authority
• Doctors have created vaccum by not organizing and managing care themselves into which health palns are moved wherein disparaging the health plans to their patients.
• For the support and development of Anti-managed care legislative proposals, the physicians association have contributed to it.

The Patient with severe Respiratory infection who could hardly resistant to breath, who has membership in plan has been faced;

• Denial from the pharmacy in accepting the Health plan to provide the medicines
• The Plan advantages and disadvantages has not been properly communicated from the enrollment in written format, which inturn the response found out to be ridiculous
• Denial from the Health Care workers paying more for consulltation in their network, wherein they are totally clueless about the plan and not properly being informed about what is being covered in the plan
• The Prescription coverage of Health Plan are denied due to dealying in receiving the premium payment, once the same is being sent out early from the patient side.

Health Plans are not assuming the greater responsibility for managing health care, that has turned out to be negative consequences of antagonizing consumers which reflects in the loss of Business and loss of new legislation. Based on the Non-financial aspects of managed care health plans,found out to be more complaints about access to specialists test, also waiting times by whomsoever enrolled in managed care plans.

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